Objective. We conducted a national survey of
pediatric, family practice, and obstetrics and gynecology
residency program directors to determine the curriculum
content and predominant practices in US training programs
with regard to neonatal circumcision and anesthesia/analgesia
for the procedure.

Methods. Residency directors of accredited programs
were surveyed in two mailings of a forced response and short
answer survey (response rate: 680/914, 74%; pediatrics 83%;
family practice 72%; obstetrics 71%).

Results. Pediatric residents were less likely than
family practice [odds ratio (OR), 0.04; 95% confidence
interval (CI), 0.02-0.08] or obstetrical (OR, 0.14; 95% CI,
0.08-0.23) residents to be taught circumcision. Training and
local custom were rated as important determinants of medical
responsibility for neonatal circumcision. Pediatric residents
training in programs in which community pediatricians perform
circumcisions were more likely to learn circumcision (OR,
39.0; 95% CI, 14.3-110.6) as were obstetric residents (OR,
79.0; 95% CI, 22.4-306.4) training in programs in which
community obstetricians perform circumcision. In programs
that teach circumcision, pediatric (84%; OR, 3.4; 95% CI,
1.7-7.1) and family practice (80%; OR, 2.7; 95% CI, 1.7-4.2)
programs were more likely than obstetric programs (60%) to
teach analgesia/anesthesia techniques to relieve procedural
pain. Overall, 26% of programs that taught circumcision
failed to provide instruction in anesthesia/analgesia for the
procedure. Significant regional variations in training in
circumcision and analgesia/anesthesia techniques were noted
within and across medical specialties.

Conclusions. Residency training standards are not
consistent for pediatric, family practice, and obstetrical
residents with regard to neonatal circumcision or instruction
in analgesia/anesthesia for the procedure. Training with
regard to pain relief is clearly inadequate for what remains
a common surgical procedure in the United States. Given the
overwhelming evidence that neonatal circumcision is painful
and the existence of safe and effective anesthesia/analgesia
methods, residency training in neonatal circumcision should
include instruction in pain relief techniques.